Malaria: UK report cases in travelers to Cyprus

On September 7, 2017, the United Kingdom (UK) reported three cases of Plasmodium vivax malaria in UK residents who had traveled to Cyprus in August 2017. All travelers had visited a resort in Esentepe (also known as Agios Amvrosios) in the Kyrenia District located in northern Cyprus, and none had a history of recent travel to malaria-endemic areas.

Mature Plasmodium vivax schizont/CDC

One traveler was a 49-year-old female who visited Esentepe for 2 weeks, returned to the UK on August 19, 2017, and developed symptoms on August 29, 2017. The other 2 travelers were 12-year-old siblings who were in Esentepe for 3 weeks, returned to the UK on August 31, 2017, and had onset of symptoms on August 29, 2017.

All three cases completed treatment and fully recovered. The UK is performing whole genome sequencing of the P. vivax parasites isolated from the three cases to provide additional information about the probable source of these infections.

Cyprus was certified as a malaria-free country in 1967 by the World Health Organization. Since then, there has been no information on cases of locally transmitted malaria in Cyprus, and until now, no cases reported among visitors to Cyprus. However, mosquito vectors for malaria, Anopheles claviger, and to a lesser extent, Anopheles algerienses, Anopheles sacharovi, and Anopheles superpictus, are present in Cyprus.

CDC recommends that travelers to Esentepe (also known as Agios Amvrosios) in the Kyrenia District located in Northern Cyprus take antimalarials to prevent malaria. Effective antimalarial options include atovaquone-proguanil, chloroquine, doxycycline, primaquine, and mefloquine. CDC will continue to follow the investigation of these cases and will update these recommendations as needed.

As malaria and other diseases are spread by mosquito bites, CDC recommends that travelers use mosquito avoidance measures. These measures include using insect repellent when outdoors, wearing protective clothing, staying in an air-conditioned or well-screened area, and sleeping under an insecticide-treated bed net.